Individual
TATEM FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1919 LINCOLN WAY STE 315, COEUR D ALENE, ID 83814-2527
(208) 625-4255
Mailing address
1219 E WASHINGTON ST, BOISE, ID 83712-7328
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
ID
Other
Enumeration date
04/06/2026
Last updated
04/06/2026
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